Blossom Healthcare Services LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

BLOSSOM HEALTHCARE SERVICES LLC

Practice address

1875 Plaza Dr Ste 12C
Saint Paul, MN 55122-2613

Phone

(651) 302-9281

NPI assigned

Aug 19, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yahye Mohamed Takal

Title

Owner

Phone

(651) 302-9281

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1215769005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 PLAZA DR STE 12C",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551222613",
            "telephone_number": "651-302-9281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 PLAZA DR STE 12C",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551222613",
            "telephone_number": "651-302-9281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "TAKAL",
        "authorized_official_first_name": "YAHYE",
        "authorized_official_middle_name": "MOHAMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-302-9281"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.